Question

An OT practitioner is preparing to work with a patient who has a progressive neurological disease. The patient was previously receiving OT through home health services, but he has recently relocated to a SNF. The OT practitioner is informed by the SNF admin office that OT services will not be covered for this pt as he has a progressive diseases. Is this information correct?

A. Yes. Medicare will only pay for services intended to improve function for the pt
B. No Medicare will pay for the services intended to improve or maintain function for the patient
C. No. An appeal can be lodged for medicare to pay for services for a pt who needs maintenance.
D. OT services are never covered in a SNF stters.

Answer 1

According to Medicare guidelines, OT services can be covered for a patient with a progressive neurological disease, as long as they are deemed medically necessary. An appeal can be lodged for Medicare to pay for maintenance services if needed.

Step-by-step explanation:

According to the information provided, the SNF admin office states that OT services will not be covered for a patient with a progressive neurological disease. However, this statement is incorrect. Medicare does cover OT services for patients with progressive diseases. In fact, Medicare will pay for services intended to improve or maintain function for the patient, as long as they are deemed medically necessary.

If the patient needs maintenance OT services, an appeal can be lodged for Medicare to pay for these services. The appeal process allows for a review of the patient's individual circumstances and can result in approval for coverage. Therefore, option C is the correct answer: No, an appeal can be lodged for Medicare to pay for services for a patient who needs maintenance.